Johnson & Johnson Institute
Right hepatectomy
Operative steps
- Modified Makuuchi incision is utilized to maximize visibility while lower pain compared to subcostal incision, especially after TAP block (anesthetic/nerve block) along the lateral incision.
- Thompson bar or a similar retractor on patient’s right side should have lower bar lowered as much as possible to allow in-line view of vena cava during mobilization portion.
- Take down the falciform ligament and bilateral coronary/triangular ligaments for optimal mobilization to minimize stress on left liver when retracting the liver.
- Retrohepatic vena cava mobilization should take caution to ligate small short retrohepatic vein attachments.
- Retrohepatic suspensory ligament or Makuuchi ligament is transected to visualize right hepatic vein insertion in order to encircle the vessel.
- Dissect portal hilum to isolate the right hepatic artery and right portal vein.
- Be sure to test clamp and confirm blood flow to left liver prior transection.
- Right hepatic vein is encircled and transected with vascular stapler, such as ECHELON FLEX™ Powered Vascular Stapler.
- Important to transect the Makuuchi ligament to visualize the insertion of right hepatic vein.
References
For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.
Young K. Hong, MD prepared this procedure guide on behalf of Johnson & Johnson and its affiliates. The procedure guide reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps.
Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s).
This presentation is not accredited for CE/CME.
Young K. Hong, MD is compensated by and presenting on behalf of Johnson & Johnson and its affiliates and must present information in accordance with applicable regulatory requirements.
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